With over 72 million dogs in the United States and more than 4.7 million reported dog bites each year,1 dog bite injuries are an ever-present problem. This article will discuss the legal responsibility of dog owners, draw attention to the prevalence of dog bites, note proper wound care issues, and action steps to take if and when you or a patient is bitten.
Know the Law:
In the state of Washington, if you own a dog and it bites someone, you are strictly liable. That means that the injured party does not need to establish any negligence on your part – simple ownership is enough. The strict liability law holds a dog owner to a higher standard of responsibility because of the potential for significant injury when a dog bites a human. In Washington State, an injured party needs to establish the following to make a claim against the dog owner under the strict liability rule:
- That the defendant is the owner of the dog
- That the dog bit you
- That you were in or on a public place or lawfully in or on a private place including the property of the owner of the dog when bitten.2
- This strict liability applies regardless of the former viciousness of the dog or the owner’s knowledge of such viciousness.3 In other words, there is no “first bite free” under the law.
This strict liability does not apply in all dog bite situations. For example, proof of provocation of the attack by the injured person shall be a complete defense to an action for damages.4 Also, strict liability does not extend to the landlord of the dog owner while the dog is on a rented or leased property.5
In addition to this state wide law, many municipalities have their own laws and regulations when it comes to the proper licensure and confinement of dogs.
Dog Bite Statistics:
Each year, the American Veterinary Medical Association, the U.S. Postal Service and the Centers for Disease Control (CDC) sponsor National Dog Bite Prevention Week to raise awareness around the problem of dog bites.6 While there are 72 million dogs in the United States, any dog can bite if it feels threatened, frightened or is injured – including that friendly dog next door. According to the Centers for Disease Control and the Humane Society of the United States:
- An estimated 4.7 million dog bites occur in the U.S. each year.
- Nearly 800,000 dog bites require medical care.
- Approximately 92% of fatal dog attacks involved male dogs, 94% of which were not neutered.
- Approximately 71% of bites occur to the extremities (arms, legs, hands, feet).
- Approximately two-thirds of bites occurred on or near the victim’s property, and most victims knew the dog.
- The insurance industry pays more than $1 billion in dog-bite claims each year.
- At least 25 different breeds of dogs have been involved in the 238 dog-bite-related fatalities in the U.S.
- Approximately 24% of human deaths involved unrestrained dogs off of their owners’ property.
- Approximately 58% of human deaths involved unrestrained dogs on their owners’ property.
- Approximately 25% of fatal dog attacks involved chained dogs.7
Dog Bites and Kids:
Even more alarming are the statistics involving dog bites to young children. According to the CDC:
- 50% of dog attacks involved children under 12 years old.
- 82% of dog bites treated in the emergency room involved children under 15 years old.
- 70% of dog-bite fatalities occurred among children under 10 years old.
- Bite rates are dramatically higher among children who are 5 to 9 years old.
- Unsupervised newborns were 370 times more likely than an adult to be killed by a dog.
- 65% of bites among children occur to the head and neck.
- Boys under the age of 15 years old are bitten more often than girls of the same age.8
Common Injuries:
In a survey of Emergency Room Departments done by the CDC, injury diagnoses were described frequently as “dog bite” (26.4%); other diagnoses included puncture (40.2%), laceration (24.7%), contusion/abrasion/hematoma (6.0%), cellulitis/infection (1.5%), amputation/avulsion/crush (0.8%), and fracture/dislocation (0.4%). Overall, 98.2% of patients with dog bite injuries were treated and released from emergency departments.9
Dog bites and proper wound care:
Dog bites typically cause a crushing-type wound because of the animals’ rounded teeth and strong jaws. An adult dog can exert 200 pounds per square inch (psi) of pressure, with some large dogs able to exert 450 psi.10 Such extreme pressure may damage deeper structures such as bones, vessels, tendons, muscle, and nerves.
Standard treatment protocol for puncture-type wounds caused by dog bites centers on repeated copious saline pressure irrigation, meticulous wound and wound edge debridement, adequate antibiotic treatment, and close postoperative monitoring.11
A major concern in all bite wounds is subsequent infection. Bites of the hand generally have a high risk for infection because of the relatively poor blood supply of many structures in the hand and anatomic considerations that make adequate cleansing of the wound difficult. In general, the better the vascular supply and the easier the wound is to clean (i.e., laceration vs. puncture), the lower the risk of infection.12 Infections can be caused by nearly any group of pathogens (bacteria, viruses, rickettsia, spirochetes, fungi). At least 64 species of bacteria are found in the canine mouth, causing nearly all infections to be mixed.13 Common bacteria involved in dog bite wound infections include the following:
- Staphylococcus species
- Streptococcus species
- Eikenella species
- Pasteurella species
- Proteus species
- Klebsiella species
- Haemophilus species
- Enterobacter species
- DF-2 or Capnocytophaga canimorsus
- Bacteroides species
- Moraxella species
- Corynebacterium species
- Neisseria species
- Fusobacterium species
- Prevotella species
- Porphyromonas species
Infection occurs when the oral flora of a biting animal gains entry through breaks in the skin, or when open wounds become contaminated by bacteria in the environment. Bites that penetrate the skin have an infection rate of 6-13%. Wounds cleaned and treated in the emergency department have a rate around 5%. Polymicrobial infection is common, including both aerobic bacteria (e.g. Pasteurella, Streptococcus, and Staphylococcus species) and anaerobic bacteria (e.g. Fusobacterium, Bacteroides, Porphyromonas, and Prevotella). Different animal species have a different spectrum of potential microbes. Puncture wounds, hand wounds, and wounds that are greater than 24 hours old are at higher risk for infection. Individuals who are asplenic or immune compromised are at risk for systemic infection.14
When to Notify Public Health:
There have been some recent changes in notification when it comes to animal bites. Washington’s notifiable conditions rule was revised February 4, 2011.15 Prior to that date, you were required to notify your local health jurisdiction of any animal bite. With the recent revision, you are still required to notify health authorities, but only if you suspect human rabies exposure. Therefore, it is vital to take a detailed history from your patient. If you have treated a patient who has suffered a dog bite (or any animal bite) and you suspect rabies exposure, you should report the incident to your local health jurisdiction.
The basic elements of preventing human rabies after animal exposure include:
- Administering immediate wound care
- Assessing the risk of the patient’s exposure to rabies
- Administering rabies PEP when indicated
- Assessing tetanus vaccination status as part of wound management (using Tdap where indicated).16
Who to Bill When Treating a Patient who has Sustained a Dog Bite:
If your patient is bitten by a dog, the dog owner’s homeowner’s policy will likely contain a “Med Pay” provision for such occurrences for 100% reimbursement of the charged amount. If it does not – or if the homeowner’s policy expressly excludes protection for injuries caused by a dog – then you should bill the patient’s health insurance carrier, subject to preferred provider reduced rates.
If your patient has been injured by a dog and has any questions concerning the law or his or her rights and duties under the law, advise them to seek a consultation from experienced legal counsel that handle traumatic injury cases. The attorneys at Adler Giersch, PS are ready and willing to assist you and your patients with a complimentary consultation. Simply give us a call.
1 Centers for Disease Control (2003). Nonfatal dog bite-related injuries treated in hospital emergency departments – US 2001. MMWR, 52(26), 605-610.
2 RCW 16.08.040.
3 RCW 16.08.040.
4 RCW 16.08.060.
5 Frobig v. Gordon, 124 Wn.2d 732, 881 P.2d 226 (1994).
6 May 15-21, 2011 was National Dog Bite Prevention Week.
7 Centers for Disease Control (2003). Nonfatal dog bite-related injuries treated in hospital emergency departments – US 2001. MMWR, 52(26), 605-610; Humane Society of the United States (2005). National Pet Related Statistics. Shelter Pages, 37-38;
8 Centers for Disease Control (2003). Nonfatal dog bite-related injuries treated in hospital emergency departments – US 2001. MMWR, 52(26), 605-610.
9 Ibid.
10 Chambers, GH, Payne, JF. “Treatment of Dog Bite Wounds.” Minn Med. 1969; 52:427-430.
11 Zook EG, Miller M, Van Beek AL, Wavak P., “Successful treatment protocol for canine fang injuries.” J Trauma. 1980 Mar;20(3):243-7.
12 “Perkins AG, Adler J, “Animal Bites In Emergency Medicine.”
13 Talan DA, Citron DM, Abrahamian FM, et al., “Bacteriologic analysis of infected dog and cat bites,” N. Engl. J. Med., Jan 14 1999:340(2)85-92; Abrahamian FM. Dog Bites: Bacteriology, Management, and Prevention. Curr Infect Dis Rep. Oct 2000;2(5):446-453; Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-406.
14www.kingcounty.gov/…/zoonotics/~/media/health/publichealth/documents/zoonotics/VetManualSection5.ashx
15 WAC 246-101-101; EPI-LOG, Vol. 51 No. 4, April 2011, Public Health for Seattle and King County.
16 “Guidance for King County Health Care Providers on Assessment, Management, and Reporting of Suspected Rabies Exposures July 2011,” Communicable Disease Epidemiology and Immunization Section, Public Health for Seattle and King County.
